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Copy of The Brain

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hadeer abosalem

on 14 August 2016

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Transcript of Copy of The Brain

Personal information:

Patient’s lab tests:
Drug _Drug Interactions:
Akineton: ( Atropine like effect) :

Anticholinetrgics may increase the serum conc of thiazides

: Monitoring for increase
response of thiazide during concomitant used

Concomitant use of two or more anti muscrinic drugs may increase the risks associated with anticholinergic activity like( dry mouth, dry eyes, blurred vision, urinary retention, and constipation.) Caution is warranted

What happens if
The Primary Motor Cortex is Damaged?
case study
Name: M. W.M

Age: 62

Sex: male

Social status: ( mother dead- father dead )

Life style: smoking and alcoholism

Date of admission:
The patient was admitted to the hospital several time

because he refused treatment when he was discharged from the hospital ( low compliance ),

recurrent admission was from 2 years.
Reasons for admission:
a) He was aggressive with his family

b) He had persecutory delusions and grandiose delusions.

c) He used to fight with strangers in the street.

d) He had auditory hallucinations.

The patient was diagnosed as
Family History:
The disease is not present in the family history.
Past medical history:
a) Hypertension

b) Angina

Normal except leukocytosis
General Appearance
patient is co-operative,
oriented to time, place, people.
a) Psychodol ( rispiridone ) 0,5.1

b) Depakene ( valporic acid ) 500 mg 1x2

c) Aspirin 75 mg

d) Nitromack retard 2.5 mg

e) Capozide

f) Safinac ( haloperidol) 5 mg 1x3

g) Cognitol (benztropin) 0,5x2

The patient was prescribed to take cognitol for EPS but,
his case wasn’t controlled and some EPS appeared on the patient so,
the physician replaced it by Akineton (biperiden hydrochloride )

Then the physician added Haloperidol ampoule 50 mg for 2 weeks
The patient suffered from diarrhea and he takes Antinal
The patient was bitten by an insect, so the he was prescribed to take:

a) Augmentin (amoxicillin and clavulinate)
b) Tabrex eye drop(toberamycin)
c) Antihistaminic

Aspirin :
With Captopril

Salicylates may diminish antihypertensive effect of ACE inhibitors. Potential for dangerous interaction,

NSAIDS decrease synthesis of Vasodilators PG and thus diminish the antihypertensive effect.

( dosage adjustment of antihypertensive drug and monitoring blood pressure )

WithValproic Acid:

Salicylates increase serum conc of valproic acid and its derivatives by plasma protein binding competition

. toxicity of valproic acid can result in hyperammonemia Significant interaction is possible,

: monitor closely any sign of hyperammonemia encephalopathy"acute mental status changes" characterized by confusion, personality change, irritability, ataxia, visual disturbance, lethargy They may also present with nausea, vomiting, or hyperventilation
With Thiazide diuretics: category C
With Haloperidol and risperidone category C
Captopril :
Wth Haloperidol: category C
CYP2D6 Inhibitors (Moderate) may decrease the metabolism of CYP2D6 Substrates( captopril )
With Captopril: category C
It enhances the antihypertensive effect of nitroglycerine.

So, monitoring of blood pressure is very important


With haloperidol category C
Haloperidol and risperidone both increase antidopaminergic effects, including EPS and neuroleptic malignant syndrome

Recommendation :
Monitor sign of neuroleptic malignant syndrome ( hyperthermia , tremor ,muscle rigidity, autonomic dysfunction )

With Valproic acid: category C
Valproic Acid and Derivatives may enhance the adverse/toxic effect of RisperiDONE.

Generalized edema
has developed so,

for peripheral edema is important.

Drugs like ( haloperidol , risperidone and antihistameinic like terfinadine astramazole )

QT prolongation and

concomitant used with thiazide that


increase the risk of cardiac arrythmia

Also patient is smoker and predisposed for strock

So monitoring ECG is very important and

any sign of QT interval prolongation ( dangerous arrhythmia , abnormal heart rhythm during sleep ,unexplained fainting )

Use another anti histaminic agent instead of terfinadine and astimazole )

Drug_lab Interactions:

a) Anemia

b) Increase Bilirubin

c) Liver function test abnormalities

d) Hyperglycemia

e) Agranulocytosis

Haloperidol :

a) Increased bleeding time

b) Thrombocytopenia

Valproic acid:
Drug_food Interactions:
Patient is alcoholism

Risperidone with alcohol : category C:

ALCOHOL may enhance the CNS depressant effect of risperidone

Thiazid with alcohol: category C:

Alcohol (Ethyl) may enhance the orthostatic hypotensive effect of Thiazide Diuretics.

VitE :May enhance the antiplatelet effect of aspirin(
50- 100M vitamin E reduced platelet adhesion to collagen by about 80% (
present in eggs, fruits, vegetables, and wheat germ oil)

Omega-3 Fatty Acids: May enhance the antiplatelet effect of aspirin ( fish oil present in mackerel, tuna, salmon)

Herbs (/Anticoagulant Properties) (eg, Anise,) May potentiate the effect of Salicylates.

Bleeding may occur

:Aspirin may increase the renal excretion of vitamin C and may decrease serum folate levels;

So increasing the dietary intake of foods that are high
in vitamin C and folic acid is essential

Risperidone :
. It should not be mixed with cola or tea

sedative effects of some herbs may increase CNS side effects of risperdone eg. chamomile ,


1- The physician prescribed Haloperidol deconate ampoule 50 mg due to the low compliance of the patient as refused to take his medications

2- The physician replaced cognitol with akineton as his case wasn’t controlled and some EPS appeared on the patient.

3- patient take Depakene then stop it for period of time may be due to:
Increase in liver enzymes because it is hepatotoxic drug and physician stop it till check liver state then he continue it
because patient need ECT and he should stop anticonvulsive agent before it

1-prefere to add l -carnitine to avoid hyperammonemia associated with valporic acid

2- vitamin B6 in combination with vitamin E
was used to treat a side effect of risperidone
called neuroleptic malignant syndrome and results were encouraging also may be used for preventing it

2-WHO recommended to maintain blood level of haloperidol to its lowest level needed to control patient case

And sometime it may be indicated to terminate haloperidol gradually as possible

3- psychotherapy , occupational therapy, social rehabilitation may improve patient case at least 1 % in combination with pharmacological therapy

4- Clinical response may be measured by a degree of occupancy of D2 receptor:

at least 65% of D2 receptor occupation indicate good clinical response but greater than 78% lead to EPS

5- In case of induction of neuroleptic overdose we can reverse it by :

A-Gastric lavage (if used within an hour of ingestion, may be useful in decreasing the absorption of neuroleptics.

B-Activated charcoal (bind with neuroleptic agent )
Ipecac syrup is never recommended

C-Hemoperfusion, hemodialysis, and forced diuresis are not effective.

D-Seizures are treated in a stepwise fashion, beginning with benzodiazepines (eg, lorazepam, midazolam) and followed by barbiturates (eg, phenobarbital, pentobarbital).

also give bromocriptine& amantadine ( central dopaminergic agonist to reverse neuroleptic malignant syndrome )

6 Guidelines for treatment of hypertension :

a-Sodium Reduction


c-Dietry changes

d-Limiting Alcohol consumption

e-Weight loss

f-Smoking Cessation

Prescribed medication:
Guidelines for treatment of Diarrhea :
1-Oral rehydration solution (ORS)

2-Fluid intake



Past medical history:


In vivo receptor binding can be investigated using positron emission tomography (PET) or single photon emission computerized tomography (SPECT) imaging.

1. Dursun SM, Oluboka OJ, Devarajan S, Kutcher SP. High-dose vitamin E plus vitamin B6 treatment of risperidone-related neuroleptic malignant syndrome. J Psychopharmacol 1998;12:220–1

We present a case of a 74-year-old patient with schizoaffective disorder, who developed risperidone-related neuroleptic malignant syndrome. This patient responded satisfactorily to the supportive management and vit E plus vit B6.
from Pubmed

IG -E mediated mechanism
Textbooks :

2-Clinical pharmacy and theraputic
3-drug Interaction
4-Applied therapeutics
"lippincott Williams &Wilkins"
5-Stockley`s Drug Interaction

amino acid derivative cofactor for B oxidation
synthesized from essential amino acid methionine and lysine
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